Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Clinical Trial

Abstract

Study Design Randomized clinical trial. Objectives To determine if females with patellofemoral pain syndrome (PFPS) who perform hip strengthening prior to functional exercises demonstrate greater improvements than females who perform quadriceps strengthening prior to the same functional exercises. Background Although PFPS has previously been attributed to quadriceps dysfunction, more recent research has linked this condition to impairment of the hip musculature. Lower extremity strengthening has been deemed an effective intervention. However, research has often examined weight-bearing exercises, making it unclear if increased strength in the hip, quadriceps, or both is beneficial. Methods Thirty-three females with PFPS performed either initial hip strengthening (hip group) or initial quadriceps strengthening (quad group) for 4 weeks, prior to 4 weeks of a similar program of functional weight-bearing exercises. Self-reported pain, function, and functional strength were measured. Isometric strength was assessed for hip abductors, external rotators, and knee extensors. A mixed-model analysis of variance was used to determine group differences over time. Results After 4 weeks, there was less mean ± SD pain in the hip group (2.4 ± 2.0) than in the quad group (4.1 ± 2.5) (P = .035). From baseline to 8 weeks, the hip group demonstrated a 21% increase (P<.001) in hip abductor strength, while that remained unchanged in the quad group. All participants demonstrated improved subjective function (P<.006), objective function (P<.001), and hip external rotator strength (P = .004) from baseline to testing at 8 weeks. Conclusion Both rehabilitation approaches improved function and reduced pain. For patients with PFPS, initial hip strengthening may allow an earlier dissipation of pain than exercises focused on the quadriceps. Level of Evidence Therapy, level 2b-. J Orthop Sports Phys Ther 2011;41(8):560–570. Epub 7 June 2011. doi:10.2519/jospt.2011.3499

The effect of hip and knee exercises on pain, function, and strength in patientswith patellofemoral pain syndrome: a randomized controlled trial

“…However, there are limited numbers of controlled studies on additional hip-strengthening exercises in PFPS (3,4,(18)(19)(20)(21)(22). Sex bias (18,19) and small sample size (3,4,16,19,21) were common problems in most of these studies.…”

“…Sex bias (18,19) and small sample size (3,4,16,19,21) were common problems in most of these studies. Interestingly, specific causes for differential diagnosis of knee pathologies or coexistence of different knee problems confirmed by knee radiographs or magnetic resonance imaging (MRI) were not investigated in the previous studies.…”

“…It is a common source of knee pain, especially in the physically active female population (1)(2)(3)(4)(5)(6).…”

The outcome of hip exercise in patellofemoral pain: A systematic review

“…www.casp-uk.net Beneficial effect of hip exercise in PFP Baldon et al, 2014Coppack et al, 2011Ferber et al, 2014Fukuda et al, 2010Fukuda et al, 2012Ismail et al,2013Nakagawa et al, 2008Dolak et al, 2011Khayambashi et al, 2012Avraham et al, 2007Boling et al, 2006Earl & Hoch 2011Ferber et al, 2011Khayambashi et al, 2014Lowry et al, 2008Mascal et al,2003Noehren et al .,2011Razheghi et al, 2010Tyler et al,2006Willy et al, 2012 No benefit of hip exercise in PFP Song et al, 2009 www.cebm.net/ocebm-levels-of-evidence…”

“…Only one study solely compared OKC hip and OKC knee exercise (Dolak et al, 2011). There was a 43% reduction in pain in the hip group compared to less than 3% for the knee group after a four week programme which was followed by functional exercises for both groups.The second phase was predominantly exercises in single leg stance.…”